ABSTRACT

Context.— Authorship in biomedical publications establishes accountability, responsibility,
and credit. Misappropriation of authorship undermines the integrity of the
authorship system, but accurate data on its prevalence are limited.

Objectives.— To determine the prevalence of articles with honorary authors (named
authors who have not met authorship criteria) and ghost authors (individuals
not named as authors but who contributed substantially to the work) in peer-reviewed
medical journals and to identify journal characteristics and article types
associated with such authorship misappropriation.

Design.— Mailed, self-administered, confidential survey.

Participants.— A total of 809 corresponding authors (1179 surveyed, 69% response rate)
of articles published in 1996 in 3 peer-reviewed, large-circulation general
medical journals (Annals of Internal Medicine, JAMA,
and The New England Journal of Medicine) and 3 peer-reviewed,
smaller-circulation journals that publish supplements (American Journal of Cardiology, American Journal of Medicine , and American Journal of Obstetrics and Gynecology).

Main Outcome Measures.— Prevalence of articles with honorary authors and ghost authors, as reported
by corresponding authors.

Results.— Of the 809 articles, 492 were original research reports, 240 were reviews
and articles not reporting original data, and 77 were editorials. A total
of 156 articles (19%) had evidence of honorary authors (range, 11%-25% among
journals); 93 articles (11%) had evidence of ghost authors (range, 7%-16%
among journals); and 13 articles (2%) had evidence of both. The prevalence
of articles with honorary authors was greater among review articles than research
articles (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6) but
did not differ significantly between large-circulation and smaller-circulation
journals (OR, 1.4; 95% CI, 0.96-2.03). Compared with similar-type articles
in large-circulation journals, articles with ghost authors in smaller-circulation
journals were more likely to be reviews (OR, 4.2; 95% CI, 1.5-13.5) and less
likely to be research articles (OR, 0.49; 95% CI, 0.27-0.88).

USED APPROPRIATELY, authorship establishes accountability, responsibility,
and credit for scientific information reported in biomedical publications.
However, misappropriation of authorship undermines the integrity of the authorship
system. Honorary authorship (guest or gift authorship) is defined as naming,
as an author, an individual who does not meet authorship criteria.1,2 Honorary authorship, for example, may
be bestowed as a tribute to a department chair or to the person who acquired
funding for the study.1 Ghost authorship is
defined as failure to name, as an author, an individual who has made substantial
contributions to the research or writing of the article.2

Although the International Committee of Medical Journal Editors (ICMJE)
established authorship criteria in 1985,3 and
many medical journals encourage their use,4
authors often disregard or are unaware of these criteria.5
A variety of misuses of the current authorship system have been described.1,2,6 Although previous studies
have examined the frequency of fulfillment of authorship criteria,7- 9 we know of no large-scale,
multijournal study on the prevalence of articles with honorary authors and
ghost authors or associated journal characteristics and article types.

In this study, we sought to determine the prevalence of articles with
honorary authors and ghost authors in 6 peer-reviewed biomedical journals
and to assess whether honorary authorship and ghost authorship correlated
with specific types of journals or articles. We hypothesized that research
articles in large-circulation, prestigious medical journals would be more
likely to have honorary authors, whereas review articles in smaller-circulation
journals that publish symposiums would be more likely to have ghost authors.

METHODS

We selected the 3 large-circulation US general medical journals with
the highest impact factors10: Annals of Internal Medicine, JAMA , and The New England Journal of Medicine. For comparison, we selected 3
smaller-circulation journals that previously were shown to publish symposiums11,12: American Journal
of Cardiology, American Journal of Medicine , and American Journal of Obstetrics and Gynecology. All journals
in this study follow ICMJE guidelines for authorship.

We classified all articles published in 1996 into 3 categories: original
research reports (research), reviews and other articles not reporting original
research (reviews), and editorials, commentaries, and opinion articles (editorials).
We used a computer-generated random-number list to sample research articles
from each journal to reflect the relative proportion of research articles
published in that journal compared with that of all 6 journals in 1996. Because
the 3 large-circulation journals published more reviews and editorials than
the smaller-circulation journals, we sampled all reviews and editorials from
the smaller-circulation journals and randomly selected a similar number of
reviews and editorials from the large-circulation journals. We identified
the corresponding author for each article. For individuals listed as corresponding
author for more than 1 article, we randomly selected only 1 for inclusion.
Articles with corresponding authors outside the United States were excluded.

We designed and pretested a 21-item, self-administered questionnaire
to obtain the following information: data about the corresponding author (including
demographic characteristics and experience with writing and publishing); data
about individuals who provided writing assistance or made other contributions
but were not authors; and data about the contributions and functions of coauthors.
The questionnaire was mailed to corresponding authors in July 1996 with a
cover letter signed by the editor of JAMA explaining that responses would
be kept confidential and anonymous, a photocopy of the first page of the article,
and a preaddressed, stamped return envelope. Data were abstracted, entered,
and analyzed to maintain respondent anonymity.

Based on ICMJE criteria,4 we defined
an article as having an honorary author if the corresponding author (1) reported
that he or she did not meet all of the following 3 criteria: (a) "conceiving
and designing the work" or "analyzing and interpreting the data"; (b) "writing
the manuscript or part of the manuscript" or "revising the manuscript to make
important changes in content"; and (c) "approving the final version of the
manuscript"; or (2) if the corresponding author indicated that he or she would
not "feel comfortable explaining the major conclusions" of the article; or
(3) if the corresponding author reported that a coauthor performed "only one
function and nothing else" from a list of 17 activities (supervising work
of coauthors; recruiting coauthors; recruiting study subjects; analyzing and
interpreting data; conducting literature search; analyzing and interpreting
literature; reviewing the manuscript; communicating with the journal editor;
signing a copyright transfer statement; conceiving and designing the work;
collecting data; obtaining funding or material support; performing statistical
analysis; writing the manuscript or part of it; approving the manuscript before
journal submission; revising the manuscript, making important content changes;
and reviewing edited page proofs).

We defined an article as having a ghost author if the corresponding
author reported that (1) an individual who was not listed as an author made
contributions that merited authorship; or (2) an unnamed individual participated
in writing the article. We also examined the acknowledgment section of articles
meeting these criteria to determine if any individuals were acknowledged for
writing or editing assistance.

The article served as the unit of analysis for determining the prevalence
of honorary authors, ghost authors, or both and as a composite end point of
articles with honorary authors, ghost authors, or both. Based on previously
published reports of approximately 20% prevalence of honorary authors,7,8 we estimated that 325 articles would
be required in each group of journals to detect a 10% difference between groups
with β of .20 and 2-tailed α of .05. Frequencies were calculated
using Statistical Program for the Social Sciences (SPSS) for Windows (6.1).13 Differences in proportions between types of articles
and groups of journals were compared with χ2 tests. Odds ratios
(ORs) and 95% confidence intervals (CIs) were calculated using Epi Info (Version
6).14

RESULTS

Usable questionnaires were returned by 809 (69%) of 1179 corresponding
authors surveyed. The median age for respondents was 47 years (range, 29-77
years) and 654 (81%) were men. A total of 590 respondents (73%) described
themselves as physicians and 318 (38%) reported an academic rank of professor.
A total of 465 respondents (57%) rated their experience in writing medical
articles as extensive, and 558 (69%) reported having published at least 10
articles in peer-reviewed journals during the previous 5 years.

Response rates by journal ranged from 57% for American
Journal of Cardiology to 83% for JAMA (Table 1). The response rate for the group of large-circulation journals
was greater than that for the group of smaller-circulation journals (76% vs
62%, P<.001). Of the 809 responses, 492 (60%)
were from authors of research articles, 240 (30%) from authors of reviews,
and 77 (10%) from authors of editorials. There were no statistically significant
differences in response rates by article type (research, 67%; reviews, 69%;
and editorials, 73%).

A total of 156 (19%) of 809 articles met our criteria for honorary authorship
(Table 2), including 38 in which
the corresponding author met the honorary authorship criteria. The prevalence
of articles with honorary authors ranged from 11% to 25% among journals and
was more common among reviews (26%) than research articles (16%) (OR, 1.8;
95% CI, 1.2-2.6). Prevalence of articles with honorary authors did not differ
significantly between large-circulation journals (22%) and smaller-circulation
journals (17%) (OR, 1.4; 95% CI, 0.96-2.03).

A total of 93 articles (11%) met our criteria for ghost authorship (Table 3), including 11 with an unidentified
medical writer. Of these 93 articles, 82 had an individual who was not listed
as an author but who made contributions that the corresponding author believed
merited authorship, 7 had an unnamed individual who participated in writing
the article, and 4 articles met both criteria. However, we do not have data
on whether these individuals met the ICMJE authorship criteria. The prevalence
of ghost authors ranged from 7% to 16% among journals, with no significant
differences by type of article (research, 13%; reviews, 10%; and editorials,
6%). Compared with the same type of articles in large-circulation journals,
the prevalence of articles with ghost authors was higher for reviews in smaller-circulation
journals (16% vs 4%; OR, 4.2; 95% CI, 1.5-13.5) and lower for research articles
(9% vs 17%; OR, 0.49; 95% CI, 0.27-0.88). Of 93 articles that met criteria
for ghost authorship, 79 had no acknowledgment section, 10 with acknowledgments
did not mention writing or editing assistance, and 4 had incomplete data in
our database.

COMMENT

Misappropriation of authorship (ie, awarding honorary authorship and
concealing ghost authorship) is incompatible with the principles, duties,
and ethical responsibilities involved in scientific publication. In this study,
approximately 1 in 4 articles demonstrated misapplication of authorship criteria
and inappropriate assignment of authorship.

Our findings are similar to those of Shapiro et al7
who surveyed authors of 184 multiauthored research articles from 10 journals
and found that at least 26% (268/1014) of authors reportedly failed to make
sufficient contributions to the research or writing to merit authorship. In
an analysis of 12 articles published in a general medical journal, Goodman8 found that approximately one third of 84 authors had
not contributed substantially to the intellectual content of the article.
Likewise, Sloan9 reported that 17% (149/884)
of authors in 193 articles published in a specialty journal did not merit
authorship.

We found that honorary authorship was more common among review articles
and editorials than research articles. It is possible that the ICMJE criteria
for authorship, specifically the criterion that requires participation in
"conception and design or analysis and interpretation of data," may be difficult
to apply to review articles and editorials. In a post hoc analysis in which
this criterion for authorship was removed, the prevalence of articles with
honorary authorship (involving the corresponding author or coauthor) decreased
from 19% to 17% overall. This prevalence was 16% (79/492) for research articles,
20% (48/240) for reviews, and 17% (13/77) for editorials, with no statistically
significant differences by article type.

Despite the large sample size of our study, the results are subject
to several limitations. First, the information in this study was based on
self-report from corresponding authors only. Second, despite assurances of
confidentiality, the response rate to our survey was 69%. We are uncertain
if nonrespondents differed systematically from respondents by demographics
or if their articles differed in rates of honorary or ghost authors, but we
suspect that underreporting is more likely than overreporting. However, even
assuming that none of the articles from nonrespondents had honorary authors
or ghost authors, a conservative estimate for the entire sample (N=1179 articles)
would place the lower bound of the prevalence rate at 13% for honorary authors,
8% for ghost authors, and 20% for the composite end point.

Third, we selected the 3 large-circulation journals based on circulation
and impact factor and the 3 smaller-circulation journals based on their more
specialized nature and history of publishing symposiums and supplements.11 In 1996, the 3 smaller-circulation journals published
19 symposiums and supplements (American Journal of Cardiology, 7; American Journal of Medicine , 10; and American Journal of Obstetrics and Gynecology, 2), but
1 of the large-circulation journals, Annals of Internal
Medicine , also published 1 supplement.

Fourth, 2 journals in our study (ie, American Journal
of Obstetrics and Gynecology16 and The New England Journal of Medicine17)
limited the number of authors listed in the article byline in 1996. We are
uncertain about how these limits may have affected our findings, although
future analysis may explore the relationship between number of authors and
evidence of authorship misappropriation.

Finally, we sampled only journals and corresponding authors from the
United States and sent letters of invitation from a single journal. Somewhat
different results might have been obtained if our study had included international
authors and more diverse journals, if we had sent surveys from the editor
of the journal in which the article appeared, or if we had sampled all named
authors.

In conclusion, our study demonstrates that a substantial proportion
of articles in peer-reviewed medical journals have honorary authors and ghost
authors. The findings also suggest that the ICMJE authorship guidelines may
not be well understood by all authors and may be difficult to apply to certain
types of articles such as non–data-based reviews and editorials.

Rochon PA, Gurwitz JH, Cheung M, Hayes JA, Chalmers TC. Evaluating the quality of articles published in journal supplements
compared with the quality of those published in the parent journal. JAMA.1994;272:108-113.

Rochon PA, Gurwitz JH, Cheung M, Hayes JA, Chalmers TC. Evaluating the quality of articles published in journal supplements
compared with the quality of those published in the parent journal. JAMA.1994;272:108-113.

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